Epidemiology of Tuberculosis Among Non-U.S.–Born Persons in the United States, 1993–2017

Slide 1

Epidemiology of Tuberculosis Among Non-U.S.–Born Persons, United States, 1993–2017*

Surveillance, Epidemiology, and Outbreak Investigations Branch 

* As of June 1, 2018

Slide 2

Background: Non-U.S.–Born Persons with TB in the United States

 In 2017:

o A total of 9,105 tuberculosis (TB) cases were reported in the United States

 6,384 (70.1%) were in non-U.S.–born persons

 2,705 (29.7%) were in U.S.-born persons

 16 (0.2%) were in persons whose country of birth was unknown

Slide 3

The National Tuberculosis Surveillance System

 Evolved from a program begun in 1953 that collected information on each newly reported case of TB disease in the United States

 Currently includes 60 reporting areas (the 50 states, the District of Columbia, New York City, Puerto Rico, and 7 other U.S.-affiliated jurisdictions in the 

Pacific Ocean and the Caribbean Sea)

 In 1986, all reporting areas began submitting information on TB patients’ countries of birth

 Since 1993, CDC has collected additional risk factor, clinical, and laboratory information on each reported case
Slide 4

Non-U.S.–Born Persons in the United States

 Non-U.S.–born persons are those who were born outside of the United States or a U.S. territory* to parents who were not U.S. citizens

 May be naturalized U.S. citizens, legal permanent residents, visitors, workers, students, or persons with other visa statuses

 U.S. Census Bureau estimated the 2017 non-U.S.–born population in the United States at 43.5 million† (13.6% of the U.S. population)

*U.S. territories include American Samoa, Guam, Puerto Rico, U.S. Virgin Islands, and Commonwealth of the Northern Mariana Islands

† U.S. Census Bureau. Current Population Survey via Data Ferrett (http://dataferrett.census.gov/), accessed September 14, 2018

Slide 5

Reported TB Cases Among Non-U.S.–Born Persons Compared with All TB Cases, United States, 1993–2017

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

TB cases among non-U.S.–born 7,403 7,762 8,010 7,752 7,753 7,623 7,624 7,634 8,034 7,737 7,947 7,875

Total TB cases 25,102 24,206 22,726 21,210 19,751 18,286 17,499 16,308 15,945 15,055 14,835 14,499

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

TB cases among non-U.S.–born 7,745 7,845 7,780 7,643 6,996 6,768 6,560 6,306 6,222 6,264 6,406 6,356 6,384

Total TB cases 14,065 13,727 13,280 12,889 11,514 11,100 10,504 9,935 9,561 9,398 9,547 9,253 9,105

Slide 6

Number and Percentage of TB Cases Among Non-U.S.–Born Persons, United States, 1993–2017

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Number of cases 7,403 7,762 8,010 7,752 7,753 7,623 7,624 7,634 8,034 7,737 7,947 7,875

Percentage of total cases 29.5 32.1 35.2 36.5 39.3 41.7 43.6 46.8 50.4 51.4 53.6 54.3

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Number of cases 7,745 7,845 7,780 7,643 6,996 6,768 6,560 6,306 6,222 6,264 6,406 6,356 6,384

Percentage of total cases 55.1 57.2 58.6 59.3 60.8 61.0 62.5 63.5 65.1 66.7 67.1 68.7 70.1
Slide 7

TB Case Rates Among U.S.-Born and Non-U.S.–Born Persons, United States, 1993–2017

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

U.S. overall 9.7 9.2 8.5 7.9 7.2 6.6 6.3 5.8 5.6 5.2 5.1 5.0

U.S.-born 7.4 6.8 6.1 5.6 4.9 4.4 4.0 3.5 3.2 2.9 2.7 2.6

Non-U.S.–born 34.0 36.1 38.0 32.0 30.9 28.9 28.1 26.5 27.6 25.5 23.9 23.2

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

U.S. overall 4.8 4.6 4.4 4.2 3.8 3.6 3.4 3.2 3.0 2.9 3.0 2.9 2.8

U.S.-born 2.5 2.3 2.1 2.0 1.7 1.6 1.5 1.3 1.2 1.1 1.1 1.0 1.0

Non-U.S.–born 22.3 21.7 20.9 20.2 18.8 17.6 17.0 16.0 15.7 15.5 15.2 14.7 14.7

Slide 8

TB Case Rates* Among U.S.-Born and Non-U.S.–Born Persons, United States, 1993–2017

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

U.S. overall 0.98 0.96 0.93 0.90 0.86 0.82 0.80 0.76 0.75 0.72 0.71 0.69

U.S.-born 0.87 0.83 0.78 0.75 0.69 0.64 0.60 0.55 0.50 0.47 0.43 0.41

Non-U.S.–born 1.53 1.56 1.58 1.51 1.49 1.46 1.45 1.42 1.44 1.41 1.38 1.37

* Rates presented on a logarithmic scale

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

U.S. overall 0.68 0.66 0.64 0.63 0.57 0.55 0.53 0.50 0.48 0.47 0.47 0.46 0.45

U.S.-born 0.39 0.36 0.32 0.30 0.23 0.21 0.17 0.13 0.09 0.06 0.06 0.02 -0.01

Non-U.S.–born 1.35 1.34 1.32 1.30 1.27 1.25 1.23 1.20 1.20 1.19 1.18 1.17 1.17

* Rates presented on a logarithmic scale
Slide 9

TB Case Rates* Among Non-U.S.–Born Persons, by Reporting Area, 2017

States ≤ 14.7 (U.S. Average) States > 14.7 (U.S. Average)

Alabama

Arizona

Colorado

Connecticut

Delaware

Florida

Georgia

Idaho

Kansas

Michigan

Mississippi

Montana

Nebraska

Nevada

New Jersey

New Mexico

North Carolina

Oklahoma

Oregon

Pennsylvania

Rhode Island

South Carolina

Utah

Vermont

Virginia

Wisconsin

Wyoming

Alaska

Arkansas

California

District of Columbia

Hawaii

Illinois

Indiana

Iowa

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Minnesota

Missouri

New Hampshire

New York

New York City

North Dakota

Ohio

South Dakota

Tennessee

Texas

Washington

West Virginia

*Cases per 100,000 population
Slide 10

Percentage of Non-U.S.–Born Persons Among All TB Cases, by Reporting Area, 1993 and 2017

1993 2017

No cases <25% 25%–49% ≥50% No cases <25% 25%–49% ≥50%

South Dakota

Vermont

Alabama

Alaska

Arkansas

Delaware

District of Columbia

Florida

Georgia

Illinois

Indiana

Kentucky

Louisiana

Michigan

Mississippi

Missouri

Montana

Nebraska

New York City

North Carolina

Ohio

Oklahoma

Pennsylvania

South Carolina

Tennessee

Texas

West Virginia

Wyoming

Arizona

Colorado

Connecticut

Idaho

Iowa

Kansas

Maine

Maryland

Massachusetts

Minnesota

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Dakota

Utah

Virginia

Wisconsin

California

Hawaii

Oregon

Rhode Island

Washington

Montana Alabama

Mississippi

Alaska

Arkansas 

Delaware

Kentucky

Louisiana

Oklahoma

South Carolina

South Dakota

Tennessee

West Virginia

Arizona

California

Colorado

Connecticut

District of Columbia

Florida

Georgia

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Maine

Maryland

Massachusetts

Michigan

Minnesota

Missouri

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

New York City

North Carolina

North Dakota

Ohio

Oregon

Pennsylvania

Rhode Island

Texas

Utah

Vermont

Virginia

Washington

Wisconsin

Wyoming
Slide 11

Estimates of Percentages of TB Cases Attributed to Recent Transmission Among U.S. -Born and Non-U.S.–Born Persons, 2011–2017

2011 2012 2013 2014 2015 2016 2017

Non-U.S.–born 7.8 7.7 7.4 8.3 8.3 8.0 7.6

US-born 25.5 27.0 27.1 28.0 26.6 25.4 25.9

Overall 14.2 14.6 14 14.6 14.1 13.4 12.8

Slide 12

Primary Multidrug-Resistant* TB Among U.S.-Born and Non-U.S.–Born Persons, United States, 1993–2017

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Non-U.S.–born 2.2 2.1 1.5 1.8 1.4 1.3 1.6 1.4 1.4 1.7 1.2 1.3

US-born 2.5 2.2 1.6 1.1 0.9 0.7 0.6 0.7 0.6 0.7 0.5 0.6

* Based on initial isolates from persons with no prior history of TB; multidrug-resistant TB is resistance to at least isoniazid and rifampin

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Non-U.S.–born 1.4 1.5 1.4 1.2 1.7 1.5 1.7 1.4 1.7 1.3 1.3 1.5 1.8

US-born 0.5 0.5 0.5 0.6 0.4 0.5 0.6 0.5 0.3 0.5 0.5 0.4 0.9

* Based on initial isolates from persons with no prior history of TB; multidrug-resistant TB is resistance to at least isoniazid and rifampin
Slide 13

Reported TB Cases Among Non-U.S.–Born Persons by Age Group, United States, 1993–2017

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

0–4 years 169 133 126 102 103 93 94 90 98 83 101 101

5–14 years 244 256 228 212 184 161 176 168 175 168 168 182

15–24 years 1,014 1,092 1,033 1,048 1,105 1,071 1,065 1,154 1,180 1,113 1,168 1,161

25–44 years 3,027 3,103 3,196 3,151 3,077 3,145 3,094 3,081 3,402 3,281 3,290 3,294

45–64 years 1,593 1,799 1,966 1,837 1,852 1,790 1,824 1,840 1,880 1,786 1,941 1,894

≥65 years 1,354 1,378 1,460 1,400 1,431 1,363 1,371 1,301 1,298 1,305 1,279 1,242

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

0–4 years 73 73 72 65 52 42 34 43 33 38 34 33 22

5–14 years 171 130 138 141 95 114 88 94 67 72 65 68 72

15–24 years 1,105 1,107 1,166 1,037 901 827 716 674 661 670 649 662 589

25–44 years 3,200 3,266 3,015 3,076 2,864 2,668 2,523 2,369 2,282 2,162 2,217 2,206 2,136

45–64 years 1,853 1,968 2,042 1,995 1,793 1,881 1,827 1,776 1,733 1,826 1,895 1,838 1,905

≥65 years 1,343 1,300 1,347 1,329 1,291 1,236 1,372 1,349 1,446 1,496 1,546 1,548 1,655
Slide 14

TB Case Rates Among Non-U.S.–Born Persons by Age Group, 1994–2017

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

0–4 years 57.3 58.4 38.4 40.7 34.2 36.2 30.4 27.5 22.9 33.9 29.6

5–14 years 18.4 18.9 14.1 11.7 9.7 10.9 9.6 11.1 9.5 9.5 10.9

15–24 years 33.2 35.2 30.9 32.7 30.9 29.3 29.3 29.5 27.6 27.5 26.5

25–44 years 33.4 35.8 30.2 28.1 27.0 25.7 24.6 27.4 25.0 21.7 21.7

45–64 years 36.7 37.9 32.1 31.0 28.6 28.3 25.8 24.9 23.3 23.5 21.6

≥65 years 57.5 56.3 48.4 47.7 44.0 44.5 40.9 41.0 39.4 35.9 34.3

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

0–4 years 23.5 24.6 25.8 22.2 17.2 13.7 16.2 18.3 18.6 16.0 12.9 11.6 5.9

5–14 years 10.0 7.2 8.0 8.2 6.0 7.0 5.8 6.5 4.9 5.2 4.8 5.1 5.0

15–24 years 24.6 24.0 26.5 25.2 24.6 21.6 18.3 18.2 17.3 18.1 17.2 17.6 15.6

25–44 years 20.8 20.4 18.2 18.5 17.7 16.3 15.5 14.1 14.1 13.3 13.1 12.8 12.5

45–64 years 20.2 20.8 20.3 18.5 16.1 16.5 15.7 14.4 13.4 13.8 13.9 12.9 13.0

≥65 years 36.7 32.0 32.0 30.8 29.1 25.8 28.0 26.9 28.1 27.0 25.8 24.5 27.0
Slide 15

Reported TB Cases Among Non-U.S.–Born Persons by Race/Ethnicity*, United States, 1993–2017

Race 1993 1994 1995 1996 1997 1998 1999 2000

American Indian/Alaska Native 8 5 6 6 4 5 5 6

Asian 3,299 3,443 3,665 3,480 3,494 3,329 3,337 3,218

Black/African American 630 738 797 793 875 845 924 1,038

Hispanic/Latino 2,849 2,967 2,912 2,859 2,727 2,785 2,717 2,770

Multiple race 1 . 1 . . . 2 2

Native Hawaiian/Pacific Islander 18 24 24 22 28 42 31 25

White 528 494 529 504 546 553 575 534

* All races are non-Hispanic; multiple race indicates two or more races reported for a person, but does not include persons of Hispanic/Latino origin

Race 2001 2002 2003 2004 2005 2006 2007 2008

American Indian/Alaska Native 11 2 3 3 6 3 4 3

Asian 3,320 3,160 3,297 3,182 3,077 3,164 3,303 3,243

Black/African American 1,114 1,051 1,064 1,096 1,075 1,132 1,003 1,041

Hispanic/Latino 2,965 2,974 3,088 3,107 3,073 3,051 2,968 2,875

Multiple race 2 5 28 20 22 28 15 25

Native Hawaiian/Pacific Islander 36 28 33 36 34 36 70 56

White 547 490 418 418 434 426 413 387

* All races are non-Hispanic; multiple race indicates two or more races reported for a person, but does not include persons of Hispanic/Latino origin

Race 2009 2010 2011 2012 2013 2014 2015 2016 2017

American Indian/Alaska Native 4 2 2 1 2 . 1 1 2

Asian 3,053 3,032 3,025 2,919 2,943 2,943 3,156 3,052 3,115

Black/African American 944 889 866 898 835 829 858 911 900

Hispanic/Latino 2,513 2,412 2,237 2,094 2,040 2,095 2,036 1,990 1,967

Multiple race 33 26 33 36 25 54 21 47 42

Native Hawaiian/Pacific Islander 48 57 53 42 42 51 60 47 65

White 377 335 327 298 323 278 258 286 270

* All races are non-Hispanic; multiple race indicates two or more races reported for a person, but does not include persons of Hispanic/Latino origin
Slide 16

Countries of Birth Among Non-U.S.–Born Persons Reported with TB, United States, 2017

Country of Birth 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Mexico 1,874 1,907 1,804 1,782 1,704 1,764 1,764 1,802 1,873 1,906 2,030 2,003

Philippines 1,021 1,066 1,061 1,051 1,056 969 919 869 911 871 913 830

Vietnam 889 887 1,009 868 821 755 719 670 631 658 662 622

India 284 355 387 419 482 505 566 567 614 587 609 561

China 389 406 392 389 385 372 373 411 436 356 375 350

Missing 49 89 72 50 41 15 3 3 4 6 5 6

All other 2,897 3,052 3,285 3,193 3,264 3,243 3,280 3,312 3,565 3,353 3,353 3,503

Country of Birth 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Mexico 1,962 1,931 1,841 1,762 1,593 1,543 1,445 1,311 1,247 1,281 1,255 1,191 1,210

Philippines 828 861 951 860 806 756 759 771 781 756 818 792 795

Vietnam 573 629 570 583 526 535 545 453 457 500 524 493 538

India 561 549 625 598 540 575 508 531 495 479 582 593 600

China 397 373 386 405 344 358 377 354 376 420 425 383 402

Missing 11 9 4 9 47 18 12 7 9 17 8 12 7

All other 3,413 3,493 3,403 3,426 3,140 2,983 2,914 2,879 2,857 2,811 2,794 2,892 2,832
Slide 17

TB Cases Among Non-U.S.–Born Persons by Length of U.S. Residence Before Diagnosis, 1993 –2017

Length of U.S. Residence 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

<1 year 1,519 1,529 1,524 1,474 1,427 1,329 1,494 1,628 1,767 1,492 1,431 1,633

1–4 years 1,162 1,333 1,265 1,272 1,306 1,552 1,587 1,575 1,761 1,904 1,959 1,817

5–9 years 673 727 875 902 1,113 1,213 1,106 1,055 1,062 991 1,047 1,030

10–19 years 861 979 999 1,089 1,140 1,315 1,340 1,256 1,275 1,218 1,305 1,254

20–29 years 279 329 357 407 468 568 578 609 672 690 750 767

30–39 years 103 131 129 128 184 228 214 216 264 253 277 288

≥40 years 117 96 122 150 149 192 191 218 162 160 207 205

Missing 2,689 2,638 2,739 2,330 1,966 1,226 1,114 1,077 1,071 1,029 971 881

Length of U.S. Residence 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

<1 year 1,471 1,535 1,539 1,320 1,031 1,106 945 945 962 1,009 1,071 1,119 1,040

1–4 years 1,728 1,689 1,667 1,570 1,441 1,275 1,126 1,112 1,001 938 1,026 993 1,062

5–9 years 1,122 1,186 1,164 1,179 1,104 995 1,045 940 871 859 791 765 764

10–19 years 1,286 1,331 1,256 1,271 1,291 1,192 1,323 1,208 1,242 1,176 1,248 1,242 1,153

20–29 years 758 780 840 874 816 826 769 784 825 848 791 773 831

30–39 years 343 361 375 331 415 426 466 516 481 530 567 549 552

≥40 years 189 222 194 232 227 274 289 287 286 334 335 360 355

Missing 848 741 745 866 671 674 597 514 554 570 577 555 627

Slide 18

End of Presentation with disclaimer

For more information, contact CDC

1-800-CDC-INFO (232-4636)

TTY: 1-888-232-6348 www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease 

Control and Prevention.